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Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is an uncommon multisystemic disease associated with plasma cell dyscrasia. Due to the disease's rarity and an even rarer presentation of stroke in afflicted patients, a direct association between POEMS syndrome and stroke remains ambiguous. Thrombocytosis, hyperfibrinogenemia, and increased levels of inflammatory cytokines occur in this disease, which can predispose patients to thromboembolic events. Immunomodulators can also enhance thrombosis, the chances of which increase when they are combined with dexamethasone. We present a case of a 28-year-old patient with an ischemic stroke, which may have been triggered by the combination of POEMS syndrome-associated vasculitis and the thrombogenic nature of lenalidomide-dexamethasone therapy.Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and represents a potentially fatal disease. COVID-19 is associated with a hypercoagulable state leading to increased incidence of venous thromboembolism. Arterial thrombosis has been reported, but the prevalence is not known. #link# Herein, selleck inhibitor report an unusual presentation of a 77-year-old male who presented with dyspnea and pain in left leg and was found to have acute limb ischemia. Our case adds to the limited literature regarding arterial thrombosis in COVID-19.Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.Isolated aspergillus infection of the lower limb is uncommon and needs more focus in terms of understanding the pathogenicity, ecological and geographical distribution, identification of species, management and follow-up. Aspergillus flavus involving the lower limb in an immunocompetent individual is a rare entity. Surgical management and antifungal therapy are the mainstays of treatment. link2 We report a 44-year-old farmer who presented with right lower limb swelling of short duration, operated, diagnosed with isolated species of Aspergillus flavus, treated successfully with oral voriconazole to produce excellent wound healing and functional outcome at four years follow-up.Abdominal wall reconstruction procedures have become increasingly popular in recent years as technology and surgical techniques have improved. The downside to these procedures has been the high rate of postoperative complications. Surgical site infections have been reported as high as 33.7% of the $9.8 billion spent annually on these complications. I present the case of a 62-year-old morbidly obese woman who underwent a combined procedure of abdominal wall reconstruction and panniculectomy. A total of 45 lbs of pannus was removed through a transverse incision that extended from hip to hip, measuring 90 cm in length. Following panniculectomy, abdominal wall reconstruction was performed by mobilizing the abdominal skin flap from the lower abdominal panniculectomy incision (avoiding a T-shaped incision with a traditionally high risk of dehiscence), and placement of biologic mesh as an underlay followed by fascial closure. Prevena Plus™ 125 (3M + KCI, San Antonio, TX) was applied for postoperative closed incisional negative pressure therapy (ciNPT) and continued for 10 days. No postoperative complications occurred. The incision healed without incident with no hernia recurrence at one year. ciNPT in high-risk patients can help minimize the risk of postoperative wound healing complications and should be considered in high-risk patients. Those patients undergoing combined procedures and especially morbidly obese patients undergoing combined abdominal wall reconstruction and panniculectomy are at particularly high risk for wound healing complications. ciNPT should be considered as a postoperative dressing of choice in this challenging patient population.We report a case of metastatic small cell carcinoma presenting as a rectal mass in an 80-year-old male with a history of change in bowel movement and rectal pain for six months. A computed tomography (CT) scan of the abdomen and pelvis was done, which showed a large rectal mass with many liver metastases. He had a diagnostic colonoscopy, which showed a large obstructing rectal mass, and the biopsy result came back as small cell carcinoma. He underwent palliative diverting colostomy without complications. Initially, there was a plan to treat the patient with systemic chemotherapy with etoposide and carboplatin, but given the acute kidney injury, there was a delay in treatment. After the first cycle of chemotherapy, the patient had severe nausea and vomiting. After a discussion with the patient and his family, he decided on hospice care and passed away in a few weeks.Because of a recent politically-biased Lancet editorial, the world's opinion has been directed against the Brazilian government over the rising numbers of COVID-19 cases in the country. This is an example of reporting data without accounting for important covariates. Epidemiological figures should always be corrected for population size. In fact, Brazil is not even on the list of the 10 countries with the highest number of deaths per 100,000 people. Belgium, the United Kingdom, and Spain are the most affected countries in this regard. The disinformation presented by a renowned medical journal has ignited severe criticisms against a Chief-of-State for not promoting a generalized lockdown in a country of continental size. As scientists, we have a duty to stress the caveats of science instead of fueling political attacks, and we should refrain from jumping to uninformed conclusions without considering well-analyzed data. Moreover, while there is no evidence to endorse the efficacy of a generalized lockdown in socioeconomically vulnerable populations, it is undoubtedly associated with severe nationwide adverse effects.This is a case report of a ruptured gastrointestinal stromal tumor (GIST) presenting as spontaneous hemoperitoneum. The patient was a 63-year-old female with a past medical history of hypertension and ulcerative colitis who presented to the emergency department with worsening epigastric pain. The patient denied history of trauma, previous surgeries, or forceful vomiting. She was not on anticoagulation. Vital signs at presentation were stable. A CT scan of abdomen/pelvis revealed a large amount of fluid in the upper abdomen with high attenuation material adjacent to the greater curvature of the stomach concerning for hemoperitoneum. Diagnostic laparoscopy revealed a significant amount of blood along the upper abdominal viscera. The procedure was converted to an upper midline laparotomy after identifying a necrotic, extremely friable 7 x 6 x 3 cm pedunculated mass with active hemorrhage on the posterior aspect of the greater curvature. link3 A wedge resection was performed to remove the mass with grossly negative margins. An intraoperative frozen section revealed a stromal tumor with spindle cells. Final pathology revealed a pT3N0M0 stromal tumor with histologic spindle cells and a high mitotic rate (24/5 mm2) consistent with a high-grade GIST. Given tumor rupture at presentation, the patient was started on imatinib therapy for a minimum duration of three years. GISTs are often asymptomatic or cause mild abdominal pain or GI bleeding. Rarely, an exophytic GIST may rupture leading to intraperitoneal bleeding. Surgical resection with negative margins is the mainstay of treatment although patients presenting with tumor rupture are at higher risk of dissemination and recurrence.Brain metastases (BMs) related to cancer are quite common and represent the most common brain cancer. We present a rare case of a 32-year-old female, 36 weeks pregnant, admitted to the emergency with complaints of severe headache, vomiting, and left hemiparesis associated with drowsiness. Cranial tomography showed an image suggestive of an expansive lesion in the right front-temporo-insular region with an important mass effect. The result of biopsy with immunohistochemistry was compatible with metastasis of follicular thyroid carcinoma (FTC). The knowledge of neurological characteristics in the clinical analysis of patients with thyroid carcinoma must be highly valued, both in the correct interpretation of the signs and in the early investigation through skull imaging exams.Foreign body ingestion is frequently the cause of emergency visits in the pediatric population, and these cases are challenging to diagnose and manage. In particular, the ingestion of magnets is dangerous and can lead to serious complications and even death. Urgent endoscopic intervention or surgical exploration remains the best approach for removing multiple ingested magnets and preventing further injury to the gastrointestinal (GI) tract. We report a nine-year-old child with an adjustment disorder who developed a gastrocolic fistula following the deliberate ingestion of multiple magnets. The magnets were successfully retrieved after an emergency laparotomy, and the fistula was subsequently repaired.We describe the case of a middle-aged man undergoing three-vessel coronary angioplasty due to unstable angina. Attempt to predilate a calcified lesion in the left circumflex artery with a semi-compliant balloon, inflated above the rated burst pressure, resulted in balloon rupture. Subsequently, the patient developed ST elevations and became hemodynamically unstable; slow flow in the index vessel was noted. The complication was managed with vasopressor and respiratory support, plus forceful injections of warm saline. Thrombolysis in myocardial infarction (TIMI)-3 flow was eventually restored, and the rest of the procedure was completed uneventfully. Following retrieval of the device, a longitudinal tear in the balloon was observed. This mode of rupture is considered to be safer, when compared to circumferential or pin-hole rupture. Rupture can occur when a balloon is aggressively inflated above nominal pressures and against calcific lesions. The ensuing micro- and macrovascular complications, including slow-flow, no-reflow, vessel dissection or perforation, and intramural hematoma, may induce myocardial ischemia and ultimately cardiogenic shock, malignant arrhythmias, and cardiac arrest. Management should be swift, and relies on supportive measures, depending on the degree of complications caused by the rupture.